Common Conditions that Mimic Findings of Sexual Abuse

Gail Hornor, RNC, MS, CPNP

Disclosures

J Pediatr Health Care. 2009;23(5):283-288. 

In This Article

Abstract and Introduction

Abstract

Sexual abuse is a problem of epidemic proportions in our society. Given the prevalence of sexual abuse, it is vital for medical providers, including pediatric nurse practitioners, to recognize sexual abuse in their patients and respond appropriately. Failing to recognize sexual abuse can leave children at risk for continued abuse and potentially lead to the sexual abuse of additional children. Serious ramifications also can arise when sexual abuse is diagnosed erroneously. Children can be removed from their homes and placed in foster care. An innocent person can be prosecuted. It is important for pediatric nurse practitioners to understand that the majority of children who are sexually abused will have a normal or nonspecific ano-genital examination. However, physical findings of sexual abuse are noted in approximately 4% of children who give a history of sexual abuse. Certain clinical findings can mimic sexual abuse. This article will discuss some of the more common findings mistaken for sexual abuse and assist the pediatric nurse practitioner in correctly recognizing these findings and responding appropriately.

Introduction

Sexual abuse is a problem of epidemic proportions in our society. The United States Department of Health and Human Services (2007) reports that 84,000 American children were substantiated by child protective services to be victims of sexual abuse in 2005. However, the majority of sexual abuse remains undetected. Retrospective studies of adults estimate that 20% to 25% of women and 5% to 15% of men were sexually abused as children (Berliner & Elliot, 2002).

Given the prevalence of sexual abuse, it is vital for medical providers, including pediatric nurse practitioners (PNPs), to recognize sexual abuse in their patients and respond appropriately. Failing to recognize sexual abuse can leave children at risk for continued abuse and potentially lead to the sexual abuse of additional children. Serious ramifications also can arise when sexual abuse is diagnosed erroneously: Children and families are exposed to emotional distress and upheaval, children can be removed from their homes and placed in foster care, and an innocent person could be prosecuted.

It is important for PNPs to understand that the majority of children who are sexually abused will have a normal or nonspecific ano-genital examination (Heger, Ticson, Velasquez, & Bernier, 2002). Physical findings diagnostic of sexual abuse are present in approximately 4% of children who give a history of sexual abuse (Heger, Ticson, Velasquez, & Bernier, 2002). A normal ano-genital examination does not mean that sexual abuse, including penetration, has not occurred.

The PNP who notes a finding on examination that is concerning for sexual abuse has an ethical, moral, and legal obligation to report his or her concern to child protective services. Ensuring the safety and well-being of the child is first and foremost. That being understood, the observation of a physical finding of sexual abuse in the absence of either a parental concern of sexual abuse or a verbal disclosure of sexual abuse by the child should lead the PNP to pause and consider common conditions that may mimic signs of sexual abuse. This article will discuss some of the more common findings mistaken for sexual abuse and assist the PNP in correctly recognizing these findings and responding appropriately.

Resources exist to assist primary care providers in making the diagnosis of sexual abuse. Child abuse specialists at pediatric hospitals or Child Advocacy Centers are available to provide advice and consultation to assist in diagnosing sexual abuse. Expert physical examination as well as expert forensic interviewing of children can be provided in these centers. Child Advocacy Centers provide multidisciplinary assessments that involve the teamwork of members of medical, mental health, child protective services, law enforcement, and prosecution services working together to ensure the safety of the child and link the family to needed resources. Although a primary care provider may not be in close proximity to a child abuse specialist, telephone consultation can be an invaluable resource to help in processing sexual abuse concerns with a medical provider who has experience in working with sexual abuse victims.

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